• 【發(fā)布單位】稅務(wù)總局
• 【發(fā)布文號(hào)】國稅函發(fā)[1995]089號(hào)
• 【發(fā)布日期】1995-03-06
• 【生效日期】1995-07-01
• 【失效日期】--
• 【文件來源】
• 【所屬類別】國家法律法規(guī)

國家稅務(wù)總局關(guān)于修改《外國居民享受避免 雙重征稅協(xié)定待遇申請表》的通知

 國家稅務(wù)總局關(guān)于修改《外國居民享受避免
 雙重征稅協(xié)定待遇申請表》的通知
 
（1995年3月6日國稅函發(fā)［1995］089號(hào)）

各省、自治區(qū)、直轄市和計(jì)劃單列市國家稅務(wù)局：

 根據(jù)稅制改革后的需要，我局對1991年7月1日下發(fā)使用的《外國居民享受避免雙重征稅協(xié)定待遇申請表》（國稅函發(fā)［1991］1012號(hào)）進(jìn)行了修改?，F(xiàn)將修改后的式樣印發(fā)你局。請根據(jù)你局需要自行印制，于1995年7月1日開始使用。



＿＿稅務(wù)局 外國居民享受避免雙重征稅協(xié)定待遇申請表

To__Tax Bureau Application for Treatment Under Double Taxation Agreement



 一、申請人事項(xiàng) Details of Claimant: ，19



┌─────┬─────────┬─────┬────────┬───┐
│ 個(gè) 人 │姓名 Full name │ │國籍 Nationality│ │
│Individual│─────────┼─────┼────────┼───┤
│ │住所或居所 │ │郵政編碼 │ │
│ │Domicile or │ │Postcode │ │
│ │resudence │ │ │ │
├─────┼─────────┼─────┴────────┴───┤
│ │名稱 Name │ │
│公司或團(tuán)體├─────────┼─────┬────────┬───┤
│Corporati-│總機(jī)構(gòu)所在地 │ │郵政編碼 │ │
│on or oth-│Place of Head │ │Postcode │ │
│er entity │Office │ │ │ │
│ ├─────────┼─────┼────────┼───┤
│ │實(shí)際管理機(jī)構(gòu)所在地│ │郵政編碼 │ │
│ │Place of effective│ │Postcode │ │
│ │management │ │ │ │
│ ├─────────┼─────┼────────┼───┤
│ │注冊所在地 │ │郵政編碼 │ │
│ │Place of │ │Postcode │ │
│ │registration │ │ │ │
└─────┴─────────┴─────┴────────┴───┘



 二、所得事項(xiàng) Details of Income



┌─────┬──────────┬─────────────────┐
│ 股息 │支付人名稱Payer'name│ │
│ ├────────┬─┴────┬────────┬───┤
│Dividends │地址 Address │ │郵編 Postcode │ │
│ ├────────┼──────┼────────┼───┤
│ │支付金額 Amount │ │支付日期 │ │
│ │of payment │ │Date of Payment │ │
├─────┼────────┴─┬────┴────────┴───┤
│ 利息 │支付人名稱Payer'name│ │
│ ├────────┬─┴────┬────────┬───┤
│Interest │地址 Address │ │郵編 Postcode │ │
│ ├─────┬─┬┴───┬─┬┴───┬─┬──┴─┬─┤
│ │支付金額 │ │合同簽字│ │合同有效│ │支付日期│ │
│ │Amount of │ │日期 │ │期 │ │Date of │ │
│ │payment │ │Date of │ │Period │ │payment │ │
│ │ │ │contract│ │of │ │ │ │
│ │ │ │ │ │contract│ │ │ │
├─────┼─────┴─┴──┬─┴─┴────┴─┴────┴─┤
│特許權(quán)使用│支付人名稱Payer'name│ │
│費(fèi) ├────────┬─┴────┬────────┬───┤
│ │地址 Address │ │郵編 Postcode │ │
│Royalties ├─────┬─┬┴───┬─┬┴───┬─┬──┴─┬─┤
│ │支付金額 │ │合同簽字│ │合同有效│ │支付日期│ │
│ │Amount of │ │日期 │ │期 │ │Date of │ │
│ │payment │ │Date of │ │Period │ │payment │ │
│ │ │ │contract│ │of │ │ │ │
│ │ │ │ │ │contract│ │ │ │
├─────┼─────┴─┴───┬┴─┴────┴─┴────┴─┤
│個(gè)人勞務(wù)所│職業(yè) Occupation │ │
│得 ├───────────┼────────────────┤
│ │支付人名稱 Payer's │ │
│Income of │ name │ │
│personal ├──────────┬┴─────┬────────┬─┤
│service │地址 Address │ │郵編 Postcode │ │
│ ├──────────┼─┬────┴┬─┬─────┼─┤
│ │支付金額 │ │所得項(xiàng)目 │ │支付日期 │ │
│ │Amount of payment │ │Item of │ │Date of │ │
│ │ │ │income │ │payment │ │
└─────┴──────────┴─┴─────┴─┴─────┴─┘



 三、適用的避免雙重征稅協(xié)定 Applicable Double Taxation Agreement:

 中華人民共和國同＿＿＿＿＿＿＿＿國簽訂的避免雙重征稅協(xié)定第＿＿條第＿＿款。

 Paragraph____, Article____of the Tax Agreement between the People's

Republic of China and______.



 四、聲明 Declaration

 我僅在此聲明以上呈報(bào)事項(xiàng)準(zhǔn)確無誤。

 I hereby declare that the above statement is correct and complete tothe best of my knowledge and belief.

 申請人簽名或蓋章：＿＿＿＿＿＿＿

 Claimant (Signature or Seal):_______



 五、申請人居民身份證明（申請人為其居民的締約國主管稅務(wù)機(jī)關(guān)填寫）；或另附對方主管稅務(wù)機(jī)關(guān)出具的專用證明。

 Certificate of Resident Status of Claimant (For the use of responsible

tax office of the Contracting State in which the claimant is a resident)or attach the special certificate of resident issued by responsible tax

office of the Contracting State in which the claimant is resident.



┌──────────────────────────────────┐
│ Certification │
│ We certify that_______(claimant's name) is a resident of _______ │
│according to the provision of paragraph______, of Article_________ │
│is the Double Taxation Agreement between_____and the People's │
│Repubic of China. │
│ Claimant's serial number: Date: │
│ Signature or Stamp of tax office │
└──────────────────────────────────┘

以下由中國主管稅務(wù)機(jī)關(guān)填寫(The following for the use of responsible tax

office of China only): 編號(hào)（No.）：第 號(hào)



┌──────────────┬────┬────────────┬─┐
│收到申請表日期 Date of │ │審核日期 │ │
│receipt of application │ │Date of examination │ │
├──────────────┼────┴────────────┴─┤
│審核意見 │ │
│Examination report │ │
├──────────────┼───┬─────────────┬─┤
│主辦人(簽字) Responsible │ │負(fù)責(zé)人(簽字) │ │
│officer (signature) │ │Chief officer (signature) │ │
└──────────────┴───┴─────────────┴─┘

中華人民共和國國家稅務(wù)總局

State Administration of Taxation The People's Republic of China

主管稅務(wù)機(jī)關(guān)蓋章

Stamp of tax office



 關(guān)于填寫外國居民享受避免雙重征稅協(xié)定待遇申請表的說明





 一、填報(bào)范圍和程序

 （一）本表適用同中華人民共和國簽訂避免雙重征稅協(xié)定（以下簡稱稅收協(xié)定）國家居民取得來源于中國的股息、利息、特許權(quán)使用費(fèi)，以及個(gè)人勞務(wù)所得申請享受稅收協(xié)定待遇填報(bào)。

 （二）本表由受益所有人或所得取得人填寫，一式兩份，一并送交支付人，由支付人報(bào)送當(dāng)?shù)囟悇?wù)機(jī)關(guān)。當(dāng)?shù)囟悇?wù)機(jī)關(guān)審核認(rèn)可后，退還支付人一份據(jù)以執(zhí)行。



 二、本表填寫說明

 （一）申請人事項(xiàng)：

 1．個(gè)人住所或居所填寫申請人在稅收上為其居民國家的住所或居所地址及郵政編碼。

 2．公司或團(tuán)體名稱填寫公司或團(tuán)體的全稱；總機(jī)構(gòu)、實(shí)際管理機(jī)構(gòu)或注冊所在地，填寫申請人在稅收上為其居民國家的總機(jī)構(gòu)所在地、實(shí)際管理機(jī)構(gòu)所在地或注冊所在地的地址及郵政編碼。

 （二）所得事項(xiàng)：

 個(gè)人勞務(wù)所得中的職業(yè)填寫申請人為獨(dú)立個(gè)人勞務(wù)或非獨(dú)立個(gè)人勞務(wù)；所得項(xiàng)目是指工資、薪金或勞務(wù)報(bào)酬。

 （三）其他事項(xiàng)：

 申請人填寫對表列各項(xiàng)或其他需要說明的事項(xiàng)。

 （四）該表末項(xiàng)所列主管稅務(wù)機(jī)關(guān)蓋章是指主管申請人提出該項(xiàng)稅收業(yè)務(wù)的中國縣（市）級(jí)稅務(wù)機(jī)關(guān)另蓋本級(jí)公章。



 Instructions of the "Application for Treatment

 under Double Taxation Agreement"



 1. Scope and procedure of filling the Form

 (1) The Form is applicable to those who are residents of the coun-tries concluded the Agreement for the Avoidence of Double Taxation (here-

inafter referred to as the "Tax Agreement") with the People's Republic of

China, and who claim for treatments of the Tax Agreement with respect todividends, interest, royalties and personal services income derived fromChina.

 (2) The Form is completed by beneficial owner or income recipient induplicate forwarded to the payer, then submitted to the relevant local

tax office bt the latter, One piece of the duplicate will be returned tothe payer for the enforcement upon tax office's examination and approval.

 2. Instructions for items in the Form

 (1) "Details of Claimant"

 i. Individual's domicile or residence, state the address of claimant's

domicile or residence as well as postcode in the country of claimant being

a resident for the purpose of tax.

 ii. Name of corporation or other entity, give full name; Place of head

office, effective management or registration, give address and postcode in

the country of claimant being a resident for the purpose of tax.

 (2) "Details of Income":

 "Occupation" in the personal service income column refers to indepen-

dent or dependent personal service of the claimant. "item of income" in-

cludes wages, salaries or service remuneration.

 (3) Others:

 Notes necessary by claimant on the items listed in the form or others.